Vitamin D in the Middle East and North Africa.
Vitamin D in the Middle East and North Africa.
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DOI：
10.1016/j.bonr.2018.03.004
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发表时间：
2018-06
期刊：
影响因子：
2.5
通讯作者：
El-Hajj Fuleihan G
中科院分区：
文献类型：
--
作者：
Chakhtoura M;Rahme M;Chamoun N;El-Hajj Fuleihan G
中东和北非（MENA）地区是世界上血清25 -羟基维生素D [25(OH)D]浓度最低的地区之一。我们描述了该地区维生素D缺乏症的患病率和危险因素，完成和正在进行的临床试验，以及维生素D补充的可用指南。本综述是我们小组在2013年发表的观察性研究综述和2015年发表的该地区随机对照试验（rct）综述的更新。我们在Medline、PubMed、Embase和Cochrane图书馆进行了全面检索，使用与维生素D、维生素D缺乏症和中东和北非地区相关的MeSH术语和关键词，对2012-2017年的观察性研究和2015-2017年的随机对照试验进行了全面检索。我们纳入了至少100名受试者/项研究的大型横断面研究，以及每组至少50名受试者的随机对照试验。我们确定了41项观察性研究。维生素D缺乏症（定义为25 -羟基维生素D [25(OH)D]水平低于20 ng/ml的理想水平）的患病率在儿童和青少年中为12-96%，在孕妇中为54-90%。在成人中，它的范围在44%到96%之间，平均25(OH)D在11到20 ng/ml之间变化。一般来说，25(OH)D水平低的显著预测因子是女性性别、年龄和体重指数的增加、面纱、冬季、使用防晒霜、较低的社会经济地位和较高的纬度。我们检索了2015-2017年期间发表的14项比较补充剂与对照组或安慰剂的随机对照试验：2项儿童试验，8项成人试验，4项孕妇试验。在儿童和青少年中，需要1000-2000 IU/ D的维生素D剂量才能将血清25(OH)D水平维持在目标水平。在成人和孕妇中，25(OH)D水平的增加与剂量成反比，≤2000 IU/ D的剂量为每100 IU/ D 0.9至3 ng/ml，≥3000 IU/ D的剂量为每100 IU/ D 0.1至0.6 ng/ml。虽然补充维生素D对成人血糖指数的影响仍存在争议，但补充维生素D可能对孕妇预防妊娠糖尿病有保护作用。在唯一确定的老年人研究中，600 IU/天和3750 IU/天剂量对骨矿物质密度没有显著差异。我们没有发现任何骨折研究。该区域现有的维生素D指南以专家意见为基础，建议剂量在400至2000 国际单位/天之间，具体取决于年龄类别和国家。维生素D缺乏症在中东和北非地区很普遍，要达到理想的25(OH)D水平20 ng/ml，可能需要1000-2000 IU/ D的剂量。需要研究评估这类剂量的维生素D对主要结果的影响，并确认其长期安全性。维生素D缺乏症在中东和北非很普遍。试验表明，每天需要1000-2000 国际单位的维生素D剂量。需要随机试验来制定严格的、针对特定地区的维生素D指南。
The Middle East and North Africa (MENA) region registers some of the lowest serum 25‑hydroxyvitamin D [25(OH)D] concentrations, worldwide. We describe the prevalence and the risk factors for hypovitaminosis D, completed and ongoing clinical trials, and available guidelines for vitamin D supplementation in this region. This review is an update of previous reviews published by our group in 2013 for observational studies, and in 2015 for randomized controlled trials (RCTs) from the region. We conducted a comprehensive search in Medline, PubMed, and Embase, and the Cochrane Library, using MeSH terms and keywords relevant to vitamin D, vitamin D deficiency, and the MENA region, for the period 2012–2017 for observational studies, and 2015–2017 for RCTs. We included large cross-sectional studies with at least 100 subjects/study, and RCTs with at least 50 participants per arm. We identified 41 observational studies. The prevalence of hypovitaminosis D, defined as a 25‑hydroxyvitamin D [25(OH)D] level below the desirable level of 20 ng/ml, ranged between 12–96% in children and adolescents, and 54–90% in pregnant women. In adults, it ranged between 44 and 96%, and the mean 25(OH)D varied between 11 and 20 ng/ml. In general, significant predictors of low 25(OH)D levels were female gender, increasing age and body mass index, veiling, winter season, use of sun screens, lower socioeconomic status, and higher latitude. We retrieved 14 RCTs comparing supplementation to control or placebo, published during the period 2015-2017: 2 in children, 8 in adults, and 4 in pregnant women. In children and adolescents, a vitamin D dose of 1000–2000 IU/d was needed to maintain serum 25(OH)D level at target. In adults and pregnant women, the increment in 25(OH)D level was inversely proportional to the dose, ranging between 0.9 and 3 ng/ml per 100 IU/d for doses ≤2000 IU/d, and between 0.1 and 0.6 ng/ml per 100 IU/d for doses ≥3000 IU/d. While the effect of vitamin D supplementation on glycemic indices is still controversial in adults, vitamin D supplementation may be protective against gestational diabetes mellitus in pregnant women. In the only identified study in the elderly, there was no significant difference between 600 IU/day and 3750 IU/day doses on bone mineral density. We did not identify any fracture studies. The available vitamin D guidelines in the region are based on expert opinion, with recommended doses between 400 and 2000 IU/d, depending on the age category, and country. Hypovitaminosis D is prevalent in the MENA region, and doses of 1000–2000 IU/d may be necessary to reach a desirable 25(OH)D level of 20 ng/ml. Studies assessing the effect of such doses of vitamin D on major outcomes, and confirming their long term safety, are needed. Hypovitaminosis D is prevalent in the Middle East and North Africa. Trials suggest that a vitamin D dose of 1000–2000 IU/day is needed. Randomized trials are needed to develop rigorous and region-specific vitamin D guidelines.